Advance directives are beneficial for any person regardless of whether they are ill or not. They become very important when a person is unable to make their own health care decisions because of an accident, the development of an acute illness, a chronic illness or a terminal illness. Advance directives provide a person the opportunity to communicate their wishes, in writing, related to health care treatment, end-of-life care, and the choice of identifying someone to make decisions about their health care if they are unable, therefore ensuring their healthcare choices are honored (Watson, 2010). There are two types of advance directives, the living will and the durable power of attorney for health care.

Power of attorney

The durable power of attorney for healthcare is a trusted individual that a person appoints to make legal medical decisions regarding healthcare care if they are unable. If a person has not appointed someone to be their durable power of attorney for healthcare in their advance directive, a healthcare surrogate will be appointed. A healthcare surrogate is someone that is not appointed by the person, but makes medical decisions for them if they are unable. A healthcare surrogate will be appointed by a healthcare organization’s ethics committee and/or the person’s health care provider. Although the person has no say who is appointed as the healthcare surrogate, the health care organization’s ethics committee/and or the patient’s healthcare provider will ensure they appoint someone that will make the best decisions for the person  (Abdelmalek, Goyal, Narula, Paulino, & Thomas-Hemak, 2013).

Advance directive options

People have various choices when executing an advance directive.  Choices include (a) being a full code, which includes life sustaining treatment; (b) do not resuscitate, which means that no resuscitation is to be done if the patient experiences cardiac arrest; (c) do not intubate, which means the person is not to be put on life support; (d) trial of treatment/best medical practice, is when a person receives aggressive treatment for a certain amount of time. If the person does not improve, withdrawal of care is discussed with the power of attorney for healthcare or healthcare surrogate. Other options people discuss with their health care provider when they have a chronic illness, poor prognosis, or terminal illness are palliative care, hospice care, and do-not-hospitalize.  Palliative care is implemented when a patient has a terminal illness or poor prognosis. The goal is to keep the person comfortable. Hospice care is provided to patients who have 6 months or less to live. The goal is to provide holistic care, including physical, emotional, social, and spiritual needs. Do-not-hospitalize is when people with advanced chronic conditions choose not to be hospitalized, and rather are given comfort care if they should suffer an acute episode (Abdelmalek et al., 2013).

Benefits of having an advance directive

The benefit of having an advance directive is that this legal document allows a person to have their healthcare choices honored if they are unable to verbally state what type of treatment they want and do not want, or appointment someone that will follow through with their healthcare decisions. In order for an advance directive to be beneficial, a person must execute one before a health care crisis occurs.

References

Abdelmalek, C., Goyal, S., Narula, A., Paulino, R., & Thomas-Hemak, L. (2013, January/February). Advance directives: Give teeth to end-of-life choices. Aging Well, 6(1), 24-27.

Watson, E. (2010). Advance directives: Self-determination, legislation, and litigation issues. Journal of Legal Nurse Consulting, 21(1), 9-14.

Blanca Miller, PhD, RN is an assistant professor of nursing at Illinois State University, Mennonite College of Nursing in Normal, Illinois. Her research interests include end-of-life care, nursing education, and diversity.